NPIMap

Organization Active NPI

Southern Illinois University Student

  • Institutional Pharmacy
  • Carbondale, IL
National Provider Identifier
1124064035
Registry record updated Apr 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Institutional PharmacyTaxonomy code 3336I0012X
License
054.017089 Issued in IL
Legal business name
SOUTHERN ILLINOIS UNIVERSITY STUDENT
Practice address
374 E Grand Ave
Carbondale, IL 62901-3962
Phone
(618) 453-4417
Fax
(618) 453-4672
NPI assigned
Jun 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 11, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Susan Chaney, RPH
Title
Pharmacy Director
Phone
(618) 453-4417

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Institutional Pharmacy 3336I0012X 054.017089 IL Primary

Addresses

Primary practice location

374 E Grand Ave
Carbondale, IL 62901-3962

Mailing address

374 E Grand Ave
Carbondale, IL 62901-3962
Phone (618) 453-4417

Other identifiers 1

IdentifierTypeStateIssuer
2016773OtherPK

Other names 1

  • SOUTHERN ILLINOIS UNIVERSITY STUDENT Doing business as

National Provider Directory

National Provider Directory
Tax ID family
DRS Herald and Thompson29 organizations share this tax ID, including this one

Other organizations with this tax ID 28

Organizations that report the same tax identification number in the National Provider Directory.

View all 28

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460332800000",
    "number": "1124064035",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "374 E GRAND AVE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013962",
            "telephone_number": "618-453-4417",
            "fax_number": "618-453-4672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "374 E GRAND AVE",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629013962",
            "telephone_number": "618-453-4417",
            "fax_number": "618-453-4672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS UNIVERSITY STUDENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2016-04-11",
        "status": "A",
        "authorized_official_last_name": "CHANEY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_title_or_position": "PHARMACY DIRECTOR",
        "authorized_official_telephone_number": "618-453-4417",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "3336I0012X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Institutional Pharmacy",
            "state": "IL",
            "license": "054.017089",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2016773",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SOUTHERN ILLINOIS UNIVERSITY STUDENT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Carbondale, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.